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How effective are national programmes on maternal and child health (MCH) in promoting women's equitable access to health care?

Date: Thursday 1 November 15.45–17.15
Source: Forum 11
Authors: Zhang Tuohong, Professor, Department of Health Policy and Management, School of Public Health, Peking University, People's Republic of China
with Joanna Raven, Lennart Bogg and Eva Johansson


The Law of Maternal and Infant Care in China was enacted in 1995 and was followed by national programmes that aim to improve health for all women, and pregnant women in particular. The focus of this research is on assessing women's access to maternal and child health (MCH) services, including for those women who live far from health facilities and have low incomes. The research also aims to offer strategies for the government to develop MCH services.

Qualitative approaches, including focus group discussions and key informant interviews, were adopted to explore how MCH services worked in improving health care for women in six counties of three provinces with varying socioeconomic development. Both health-care providers and users were interviewed using a semi- structured topic guide. The relevant questions to this study were: How are MCH services funded and how are MCH facilities equipped? What groups of women use the MCH facilities? Which groups do not use these services and why?

Although MCH services have been widely recognized as an important component of public health, they are not yet well funded. Most MCH facilities have to make money through fee-for-service approaches, for health promotion, prenatal care and postnatal visits. In addition, the infrastructure and equipment are less than satisfactory, especially at township level. Because the women have to pay an out-of-pocket fee for their perinatal care, the poorest choose not to have prenatal check-ups and deliver at home. Some women deliver at home because of transportation difficulties. This happens most frequently in mountainous and poor counties, and those with less satisfactory health facilities. Lack of health care awareness and health information is another reason why women deliver at home.

National programmes on MCH need to focus more on the poor and those who live in remote areas. In addition, prenatal check-ups and postnatal visits should be strengthened to ensure the mothers' safety.